The objective of this study was to do a trend analysis of the incidence of first-listed diagnosis of fractures of the skull and face (S&F) bones (ICD codes 800-804) from the Indian Health Service (IHS) Direct and Contract General Hospital Inpatient database for the fiscal years 1980 through 1988. This database is estimated to represent about a million Native Americans seeking treatment each year. This database is one of the few hospital discharge databases containing cause-specific injury data coded according to external cause of injuries (ICD-E codes). The results showed that the incidence of fractures of all bones (ICD codes 800-829) for Native Americans generally declined during this 9-yr period from about 4,000 in 1980 to about 2800 in 1988. S&F fractures also showed a general decline from about 700 in 1980 to about 470 in 1988. During this period, S&F fractures averaged about 17% of all fractures and major causes of S&F fractures were: assault (35%), falls( 24%), motor vehicle & road accidents (20%), and other accidents (8%).